The Influence of High Heel Shoes and Toe Walking on Gait Kinematics and Kinetics

Abstract

For generations, many women included high heel shoes as a part of their fashion wardrobe. Despite the claims of deleterious effects from wearing high heel, such as foot deformities, leg and back pain, and tendonitis, women still continue to buy and wear high heel shoes. Past research has reported that walking in high heel shoes affected spatiotemporal, kinematic, kinetic variables, as well as gastrocnemius pennation angles. Over the years, many inventors devised products aimed at relieving the effects of wearing high heel shoes. One product, Insolia®, claims to alter the position of the foot in the shoe so as to improve the posture of the individual while walking in high heel shoes. Non-pathological toe walking is similar to walking in high heel shoes in that an individual is walking with the foot in a plantar flexed position. The main difference between toe walking and high heel walking is that during toe walking, the heel of the individual does not make contact with the ground. While walking in high heel, an individual has the opportunity to make heel contact with the floor, if only through the heel of the shoe. This is the first study, to this author’s knowledge, that will compare spatiotemporal, kinematic, and kinetic variables while walking under the following conditions: barefoot, high heel, high heel with insert, and toe walking. In addition, to the author’s knowledge, this is the first study to compare the pennation angle of the medial gastrocnemius while standing under the above mentioned conditions. The purpose of this study was to: (1) investigate how walking with an elevated heel, such as walking in high heel shoes, walking in high heel shoes outfitted with Insolia® inserts, or toe walking affect the kinematic and kinetic variables of gait; (2) investigate if wearing high heel shoes with Insolia® inserts during gait brings electromyographic variables closer to those variables observed while engaged in barefoot gait; (3) investigate if wearing high heel shoes, wearing high heel shoes outfitted with Insolia® inserts, or standing in plantar flexion, as observed with toe walking, alters the pennation angle of the gastrocnemius.

Examination of footwear effects indicated that footwear had a significant effect on knee and hip flexion, distance from center of gravity to foot at initial contact, stride length, change in height, absolute change in height, braking in the anterior/posterior direction, and vertical ground reaction forces at heel strike transient, foot loading, and toe off. Specifically, the toe walking condition exhibited significantly smaller knee flexion at initial contact and through midstance than the barefoot or high heel and high heel with insert conditions. Results indicated no significant differences between barefoot and toe walking conditions when measuring hip flexion at initial contact and through midstance. However, barefoot and toe walking hip flexion was significantly smaller than that detected with the high heel and high heel with insert condition. Measurements of the horizontal distance from the center of gravity to the foot at initial contact revealed that the barefoot condition was significantly smaller than the high heel, high heel with insert, and toe walking conditions. Additionally, it was also revealed that the high heel and high heel with insert conditions afforded significantly smaller distance from center of gravity to foot at initial contact than the toe walking condition. Stride length was significantly longer in the barefoot condition than the other three footwear conditions. Change in height and absolute change in height were significantly smaller in the barefoot condition when compared to the other footwear conditions. Results indicate that ground reaction forces in the anterior/posterior direction during the barefoot condition exhibiting significantly less braking when compared to high heel with insert and toe walking conditions. No significant differences were found between the barefoot and high heel conditions with regard to braking. Additionally, no significant differences were found in propulsion in the anterior/posterior direction. Vertical ground reaction force results indicated that the barefoot condition exhibited a significantly smaller heel strike transient than the high heel or high heel with insert conditions. Foot loading in the barefoot condition resulted in significantly ground reaction force than the other four footwear conditions. At toe off, the barefoot condition exhibited significantly less propulsive force than the toe walking condition.

The current study found that mean and peak muscle activation displayed similar results. Gastrocnemius muscle activation was significantly higher in the toe walking condition than in the high heel and high heel with insert conditions. The biceps femoris exhibited significantly higher muscle activation than that detected in the high heel condition. However, no significant differences were found between toe walking and high heel with insert. No significant differences in muscle activation were found in the tibialis anterior, rectus femoris, rectus abdominis, or erector spinae. Finally, when examining the pennation angle of the medial gastrocnemius while standing under all four conditions, it was revealed that the barefoot condition exhibited a significantly smaller pennation angle than that observed while standing in high heel, high heel with insert, or toe walking condition. The toe walking condition exhibited a significantly larger pennation angle than the high heel or high heel with insert conditions. Interestingly, the high heel and high heel with insert conditions did not reveal significant differences amongst all of the variables measured.

Overall, the Insolia® insert did not significantly alter kinematic, kinetic, electromyographic, or pennation angle variables observed while walking in high heel as no significant differences were detected between the high heel and high heel with insert conditions. However, continuums were revealed in knee flexion, hip flexion at midstance, distance from center of gravity to foot contact, and gastrocnemius pennation angle. The observance of the aforementioned continuums indicate that altering the position of the foot while walking, through either high heel or toe walking, some kinematic variables and pennation angle of the gastrocnemius change when compared to barefoot gait. Toe walking appears to illicit more alterations in gait than when walking in high heel, thus, indicating that the toe walking condition may be more taxing to the body than the high heel condition. Additionally, the results from the current study can add to the body of knowledge for gait studies.